Patient-specific medication management system

ABSTRACT

Systems for use with a medical device for reducing medication errors are provided. In one aspect, a system includes a medical device that is configurable with operating limit parameters for providing medication to a patient, and a limiting system. The limiting system includes a memory that includes patient-specific information for the patient and a database includes acceptable operating parameters for providing the medication to the patient using the medical device, and a processor. The processor is configured to compare the acceptable operating parameters with the patient-specific information, and provide a modification of the operating limit parameters for providing the medication to the patient based on the comparison of the acceptable operating parameters with the patient-specific information. Methods and machine-readable media are also provided.

BACKGROUND

1. Field

The present disclosure relates generally to systems and methods formanaging patient care in a health care facility, and more particularly,to systems and methods for integrating and managing information withrespect to medical care, medication delivery, asset identification, andverification of drug delivery.

2. Description of the Related Art

Medication errors, that is, errors that occur in the ordering,dispensing, and administration of medications, regardless of whetherthose errors cause injury or not, are a significant consideration in thedelivery of healthcare in the institutional setting. Additionally,adverse drug events (ADE), which are defined as injuries involving adrug that require medical intervention and are a subset of medicationerrors, represent some of the most serious medication errors areresponsible for a number of patient injuries and death.

Healthcare facilities continually search for ways to reduce theoccurrence and severity of medication errors. Various systems andmethods are commonly used to reduce the frequency of occurrence andseverity of preventable adverse drug events (PADE) and other medicationerrors. In the administration of medication, focus is typically directedto the following five “rights” or factors: the right patient, the rightdrug, the right route, the right amount, and the right time. Systems andmethods seeking to reduce ADEs and PADEs should take these five rightsinto consideration.

Delivery, verification, and control of medication in an institutionalsetting have traditionally been areas where errors can occur. In atypical healthcare facility, a physician enters an order for amedication for a particular patient. This order may be handled either asa simple handwritten order, or it may be entered into an automatedsystem, such as a physician order entry (POE) system. The handwrittenorder or the electronic prescription from the POE system is routed tothe pharmacy, where the order is filled. Typically, pharmacies check thephysician order against possible allergies of the patient and forpossible drug interactions in the case where two or more drugs areprescribed, and also check for contraindications. Depending on thehealthcare facility, the medication may be identified and gatheredwithin the pharmacy and placed into a transport carrier for transport toa nurse station. Once at the nurse station, the prescriptions are againchecked against the medications that have been identified for deliveryto ensure that no errors have occurred.

Such a system works well to verify that patients are receiving theappropriate drug when drugs are delivered orally. But the system may notbe capable of thoroughly verifying that the correct administration of anintravenous (IV) drug is being provided to a patient. Incorrectadministration of the medication may occur where the medication is to beadministered using an automated or semi-automated administration device,such as an infusion pump (e.g., including large volume infusion orsyringe type pumps), if the automated device is programmed withincorrect medication administration parameters. For example, even wherethe medication order includes the correct infusion parameters, thoseparameters may be incorrectly entered into an infusion pump, causing theinfusion pump to administer the medication in a manner that may notresult in the prescribed treatment. Furthermore, if the infusion pump isconfigured with certain operating limit parameters, the operating limitparameters may reflect values that are generally considered safe for atypical patient but that may be unsafe for the patient to whom themedication is being delivered.

SUMMARY

According to one embodiment of the present disclosure, a system for usewith a medical device for reducing medication errors is provided. Thesystem includes a medical device that is configurable with operatinglimit parameters for providing medication to a patient, and a limitingsystem. The limiting system includes a memory that includespatient-specific information for the patient and a database includesacceptable operating parameters for providing the medication to thepatient using the medical device, and a processor. The processor isconfigured to compare the acceptable operating parameters with thepatient-specific information, and provide a modification of theoperating limit parameters for providing the medication to the patientbased on the comparison of the acceptable operating parameters with thepatient-specific information.

In certain aspects of the system, the medical device is configurablewith operating limit parameters for providing a mixture includes aplurality of medications to a patient, and the database includesacceptable operating parameters for providing the mixture to the patientusing the medical device. The patient-specific information can includelaboratory data for the patient. The laboratory data can include atleast one of a blood coagulation measure, a vitamin level, a plateletcount value, a thromboplastin time, or a serum level. Thepatient-specific information can include at least one of a medicationordered for the patient, a time at which the medication is ordered forthe patient, a treatment plan for the patient, a medication resistanceof the patient, a weight of the patient, a height of the patient, a bodysurface area of the patient, an age of the patient, a gender of thepatient, or an ethnicity of the patient. In certain aspects of thesystem, the processor being configured to compare the acceptableoperating parameters with the patient-specific information includes theprocessor comparing a first weight of the patient provided to themedical device with a second weight of the patient provided to anothermedical device. In certain aspects of the system, the processor beingconfigured to provide the modification of the operating limit parametersfor providing the medication to the patient includes the processor beingconfigured to modify the operating limit parameters based on adetermination of the acceptable operating parameters for a person havingthe patient's body surface area. The acceptable operating parameters caninclude a plurality of rules indicating whether the patient-specificinformation includes a value that is within or exceeds a thresholddefine by at least one of the plurality of rules. At least one of therules can indicate a maximum total amount of the medication to provideto the patient over a period of time. The medical device can include aninfusion pump. The operating limit parameters can include at least oneof a rate at which to provide the medication, an amount of themedication to provide, and a length of time to provide the medication.In certain aspects of the system, the processor being configured toprovide the modification of the operating limit parameters based on thepatient-specific information includes the processor being configured todefine at least one of a maximum value or minimum value for at least oneoperating limit parameter associated with delivery of the medication tothe patient based on the patient-specific information. In certainaspects of the system, the processor being configured to provide themodification of the operating limit parameters based on thepatient-specific information includes the processor being configured todefine at least one of a pair of a soft maximum value that can beexceeded and a hard maximum value that cannot be exceeded, and a softminimum value that can be exceeded and a hard minimum value that cannotbe exceeded for at least one operating limit parameter associated withdelivery of the medication to the patient based on the patient-specificinformation. The processor can further be configured to provide anotification to the medical device indicating that the operating limitparameters for providing the medication to the patient have beenmodified based on the patient-specific information. The processor canfurther be configured to receive an input from a caregiver to overridethe modification of the operating limit parameters. The input from thecaregiver can include an indication why the caregiver overrode themodification of the operating limit parameters. The processor canfurther be configured to record when the caregiver overrides themodification of the operating limit parameters. The processor canfurther be configured to receive configuration parameters fordetermining whether to provide the notification to the medical devicebased on at least one of an identity of a caregiver, identification of alocation of the medical device, or an institutional preference. Thepatient-specific information can be received from an external datasystem in a native message format of the external data system andconverted into an internal messaging format configured for use with thelimiting system.

According to another embodiment of the present disclosure, a method foruse with a medical device to reduce medication errors is provided. Themethod includes receiving patient-specific information for a patient,and comparing the patient-specific information with a database includesacceptable operating parameters for a medical device. The method alsoincludes providing a modification of operating limit parameters of themedical device for providing a medication to the patient based on thecomparison of the patient-specific information with the acceptableoperating parameters.

In certain aspects of the method, the medical device is configurablewith operating limit parameters for providing a mixture includes aplurality of medications to a patient, and the database includesacceptable operating parameters for providing the mixture to the patientusing the medical device. The patient-specific information can includelaboratory data for the patient. The laboratory data can include atleast one of a blood coagulation measure, a vitamin level, a plateletcount value, a thromboplastin time, or a plasma/serum concentration ofmedication, or other physiologic component, such as electrolyteconcentration. The patient-specific information can include at least oneof a medication ordered for the patient, a time at which the medicationis ordered for the patient, a treatment plan for the patient, amedication resistance of the patient, a weight of the patient, a heightof the patient, a body surface area of the patient, an age of thepatient, a gender of the patient, genetic makeup of the patient, or anethnicity of the patient. Comparing the acceptable operating parameterswith the patient-specific information can include comparing a firstweight of the patient provided to the medical device with a secondweight of the patient provided to another medical device. Providing themodification of the operating limit parameters for providing themedication to the patient can include modifying the operating limitparameters based on a determination of the acceptable operatingparameters for a person having the patient's body surface area. Theacceptable operating parameters can include a plurality of rulesindicating whether the patient-specific information can include a valuethat is within or exceeds a threshold define by at least one of theplurality of rules. At least one of the rules can indicate a maximumtotal amount of the medication to provide to the patient over a periodof time. The medical device can include an infusion pump. The operatinglimit parameters can include at least one of a rate at which to providethe medication, an amount of the medication to provide, and a length oftime to provide the medication. In certain aspects of the method,providing the modification of the operating limit parameters based onthe patient-specific information can include defining at least one of amaximum value or minimum value for at least one operating limitparameter associated with delivery of the medication to the patientbased on the patient-specific information. In certain aspects of themethod, providing the modification of the operating limit parametersbased on the patient-specific information can include defining at leastone of a pair of a soft maximum value that can be exceeded and a hardmaximum value that cannot be exceeded, or a soft minimum value that canbe exceeded and a hard minimum value that cannot be exceeded for atleast one operating limit parameter associated with delivery of themedication to the patient based on the patient-specific information. Incertain aspects of the method, the method further includes providing anotification to the medical device indicating that the operating limitparameters for providing the medication to the patient have beenmodified based on the patient-specific information. The method canfurther include receiving an input from a caregiver to override themodification of the operating limit parameters. The input from thecaregiver can include an indication why the caregiver overrode themodification of the operating limit parameters. The method can furtherinclude recording when the caregiver overrides the modification of theoperating limit parameters. The method can further include receivingconfiguration parameters for determining whether to provide thenotification to the medical device based on at least one of an identityof a caregiver, identification of a location of the medical device, oran institutional preference. The operating limit parameters of themedical device can be modified by a limiting system, and thepatient-specific information can be received from an external datasystem in a native message format of the external data system andconverted into an internal messaging format configured for use with thelimiting system.

According to one embodiment of the present disclosure, amachine-readable storage medium includes machine-readable instructionsfor causing a processor to execute a method for use with a medicaldevice to reduce medication errors is provided. The method includesreceiving patient-specific information for a patient, and comparing thepatient-specific information with a database includes acceptableoperating parameters for a medical device. The method also includesproviding the modification of operating limit parameters of the medicaldevice for providing a medication to the patient based on the comparisonof the patient-specific information with the acceptable operatingparameters.

It is understood that other configurations of the subject technologywill become readily apparent to those skilled in the art from thefollowing detailed description, wherein various configurations of thesubject technology are shown and described by way of illustration. Aswill be realized, the subject technology is capable of other anddifferent configurations and its several details are capable ofmodification in various other respects, all without departing from thescope of the subject technology. Accordingly, the drawings and detaileddescription are to be regarded as illustrative in nature and not asrestrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide furtherunderstanding and are incorporated in and constitute a part of thisspecification, illustrate disclosed embodiments and together with thedescription serve to explain the principles of the disclosedembodiments. In the drawings:

FIG. 1 is a block diagram and graphical representation of a caremanagement system for reducing the possibility of medication errors.

FIG. 2 is a block diagram illustrating an example control system,server, and medical device from the architecture of FIG. 1 according tocertain aspects of the disclosure.

FIG. 3 is functional block diagram illustrating an example process forreducing medication errors for a patient using a programmable medicaldevice, such as an infusion pump, and a control system, by referencing aguidelines database in view of information specific to the patient.

FIG. 4 is a block diagram illustrating an example computer system withwhich the control system, server, and medical device of FIG. 2 can beimplemented.

DETAILED DESCRIPTION

In the following detailed description, numerous specific details are setforth to provide a full understanding of the present disclosure. It willbe apparent, however, to one ordinarily skilled in the art that theembodiments of the present disclosure may be practiced without some ofthese specific details. In other instances, well-known structures andtechniques have not been shown in detail so as not to obscure thedisclosure.

The present disclosure provides a system that evaluates patient-specificdata, such as a patient's laboratory results or characteristics (e.g.,height, weight, gender, body surface area, medical history), in order todetermine operating limit parameters (or “dynamic guardrails”) for amedical device such as an infusion pump. Incorporating patient-specificlaboratory results and other data provides a capability to notify aclinician of scenarios to prevent potential clinical harm. Furthermore,incorporation of a patient's laboratory results and other relevantpatient data can assist clinicians in monitoring and intervening insituations related to appropriate methods of intravenous drugadministration. The present disclosure also provides for verifying thatthe right treatment, based on data specific to the right patient, hasbeen given in the right manner, in the right amount, and at the righttime.

Several examples will now be presented regarding how the disclosedsystem can assist clinicians in patient therapy. The disclosed systemcan, for example, notify a clinician at a medical device that apatient's condition has changed (e.g. change in kidney function andliver function or increasing white blood cell count) and automaticallymodify (or present modifications to) the parameters, such as maximum andminimum infusion limits, for infusing a medication to the patient basedon the changed condition for verification by the clinician. Thedisclosed system can also, for example, automatically modify infusionparameters if a patient enters a critical situation, such as a changinglab value or other condition. The disclosed system can further, forexample, modify the parameters for infusing a medication to a patient ifthe medication being infused is not associated with an active medicationorder for the patient. As another example, the disclosed system canmodify parameters for infusion of an antibiotic to a patient based onwhen and how or when the antibiotic was previously infused to thepatient. The disclosed system can, for example, modify parameters forinfusing an antibiotic if an organism affecting the patient is known tobe resistant to the antibiotic. As yet another example, the disclosedsystem can modify parameters for infusing a medication to a patient ifthe patient's record indicates the infusion should be discontinued. Asanother example, when an active order does not exist for a patientassociated with a medical device, the disclosed system can send amessage to the relevant clinician asking for an order or clarification,such as where a clinician may have given a verbal order that has notbeen documented or where an infusion may have been ordered to bediscontinued but such order was missed.

Referring now to the drawings, FIG. 1 provides an example illustrationof an integrated healthcare facility-wide information and caremanagement system 28 in accordance with certain aspects of the presentdisclosure. Various subsystems of a healthcare facility's informationmanagement system are connected together by way of a facilitycommunication system 30. The communication system 30 may include, forexample, any one or more of a personal area network (PAN), a local areanetwork (LAN), a campus area network (CAN), a metropolitan area network(MAN), a wide area network (WAN), a broadband network (BBN), theInternet, and the like. Further, the communication system 30 caninclude, but is not limited to, any one or more of the following networktopologies, including a bus network, a star network, a ring network, amesh network, a star-bus network, tree or hierarchical network, and thelike. As shown in FIG. 1, the communication system 30 connects throughvarious interfaces 32 to a healthcare facility information system 34, apharmacy information system 36, a patient information database 62, aphysician order entry system 38, a medication guidelines database 60,and a control system 40 (or “limiting system”).

The facility communication system 30 is not meant to be taken in alimited sense. Such a facility communication system 30 may encompass anentire healthcare facility or may be located only in a small area of thehealthcare facility. It may also include a communication system in ahealthcare facility other than a hospital and may have application to analternate care facility, such as a patient's home. Additionally, theword caregiver is intended to be used in its broadest sense and is meantto include nurses, physicians, health care specialists, and others whoprovide care to patients.

The control system 40 in accordance with an aspect of the presentdisclosure may be, for example, a server or other computer havingsufficient memory 42 and processing capability to connect with thecommunication system 30 and configure a medical device 80. The controlsystem 40 includes operational software or other instructions forcarrying out various aspects of the present disclosure, as will bediscussed more fully below, enabling communications with other hardwareor networks, and data input and output and report generation andprinting, among other functions. While the control system 40 is shown asa separate piece of equipment, it will be understood that the controlsystem 40 and the associated memory 42 may also be incorporated intoanother element, such as the medical device 80.

The communication system 30 may comprise, for example, a wired orwireless Ethernet (IEEE 522.3) utilizing transmitters and receiverspositioned throughout the healthcare facility and/or attached to variouscomputers, clinical devices and other equipment used in the facility. Insuch a wireless system, the signals transmitted and received by thesystem could be radio frequency (RF), infrared (IR), or other meanscapable of carrying information in a wireless manner between deviceshaving appropriate transmitters or receivers may be used. It will beimmediately understood by those skilled in the art that such a systemmay be identical to the system set forth in FIG. 1, with the exceptionthat no wires are required to interconnect the various aspects of thesystem.

In a typical healthcare facility, patient rooms, wards, or areas aretypically situated in groups located near a nurse station 44, where thecaregivers assigned to care for the patients in the particular areacarry out the administrative functions of their duties. Typically, thesefunctions include updating and monitoring the patients' charts,preparation of and administering medication orders, and monitoring andrecording any other information deemed necessary by the facility fortracking. There is also usually a room located adjacent the nursestation that is dedicated to storage and/or the preparation ofmedications to be delivered to patients. This room may containinventories of commonly used oral, IM, or IV medications. The room mayalso be used to formulate the contents of infusion bags in accordancewith prescribed treatment regimens.

The nurse station 44 will typically include a terminal or computersystem 46 connected either directly or through an interface 48 to thecommunication system 30, allowing users at the nurse station to enterand retrieve patient data or information from other systems, such as thehealthcare facility information system 34, the pharmacy informationsystem 36, the physician order entry system 38, or other systems used inthe facility. It should be understood that not all users will beprovided with access rights to each system. For example, physicians maybe able to access the physician order entry system 38 from the nursestation system 44 to enter, edit, or track medication orders, but acaregiver may only be able to view such orders. Moreover, while thepresent disclosure is described with reference to the computer system 46being located at a nurse station 44, the computer system 46 may also bea satellite system that is located anywhere in the care-giving facilitywhere it is convenient or efficient to do so. Such a satellite computersystem may be operably connected to the communication system 30 usingeither a wired or wireless network connection. A printer 50 may also beconnected to the nurse station computer system 46 for printing reports,bar codes, labels, or other materials, and a bar code reader 52 may beprovided for reading bar codes on medication labels, reports, or otheritems having bar coded labels provided for identification.

In a different embodiment where radio frequency identification (RFID)tags are used with medications, patients, equipment, or in other ways,the nurse station 44 may also include an interrogator or RFID reader(not shown) for use with the RFID tags.

In accordance with aspects of the present disclosure, a medicationdatabase carrier (MDC) or medication guidelines database 60 storesinformation that is provided to monitor medication parameters or otherinformation used by a caregiver to program a medication administrationdevice 80 to deliver medication to a patient. Various types ofinformation may be stored in the memory of the medications guidelinesdatabase 60, including data bases containing information about druginteractions and possible contraindications and/or side-effects ofmedications, and established guidelines for the administration ofvarious medications. For example, the guidelines may includeinstitutionally-established guidelines or limits on drug administrationparameters, such as dosage, frequency of administration, and otherdelivery related information such as, for example, appropriate flowrates and infusion durations for programming infusion pumps.Additionally, the guidelines may encompass guidelines for providing drugadministration appropriate to a particular patient or to treatment areashaving different sets of delivery parameters for similar medications,such as medication administration directed to geriatric, pediatric, andoncology patients. Guidelines may also be included that are directed toparticular therapy regimens, such as chemotherapy regimens or regimensfor treating chronic infection or pain. The term database as used hereinwill be understood by those skilled in the art to be used as is commonlyunderstood. That is, the term database refers to a collection of valuesor information organized, formatted, and stored in such a manner as tobe capable of being retrieved and analyzed using an appropriate programcontained in software or other form.

In one embodiment of the present disclosure, the medications guidelinesdatabase 60 may be interfaced to the nurse station computer system 46 orany other of the information systems of the central system of aninstitution through a cradle or other docking device that provides aconnection between the medications guidelines database 60 and thecomputer system 46. In this embodiment, use of the cradle allowsinformation to flow between the medications guidelines database 60 andthe nurse computer system 46. This information may then be processed andstored on the computer system 46, or the information may be communicatedby the computer system 46 through the interface 48 to various otherfacility information systems over the communication system 30. In thismanner, information from the pharmacy information system 30, forexample, may be communicated through the communication system 30, thenurse station 44 computer system 46, and to the medications guidelinesdatabase 60. Similarly, information contained within the medicationsguidelines database 60 may be communicated through the nurse stationcomputer system 46, the interface 48, and the communication system 30 toany of the interconnected systems 34, 36, 38, 40, or 62.

The medications guidelines database 60 may be stored on a device, suchas a server. The healthcare facility may also or alternatively have themedication guidelines database 60 centrally located in the memory 42 ofthe control system 40. The medication guidelines database 60 includesmedication information and/or databases or libraries, includinginstitutionally generated guidelines for the delivery of medication to apatient, as well as drug interaction information or informationconcerning possible drug side-effects, and that is portable such that itcan be carried by a caregiver to and from a patient's bedside. Themedications guidelines database 60 may also have a storage capabilityand technology for interfacing with a computer system or network so thatinformation may be communicated between the medications guidelinesdatabase 60 and other devices, such as computers, medicationadministration devices, clinical devices such as vital signs monitoringdevices and the like.

A general concept embodied in the medications guidelines database 60 isto provide medication administration parameters or other informationthat may be entered into a medication administration device 80, such asan infusion pump

In accordance with aspects of the present disclosure, the control system40 is configured to obtain patient-specific information from the patientinformation database 62, medication information from the medicationguidelines database 60, and device information from the medical device80. The patient information database 62 may itself obtain and storepatient-specific information retrieved from the physician order entrysystem 38, the pharmacy information system 36, and the healthcarefacility information system 34. In certain aspects, information may beretrieved information from the medical device 80 prior to actualmedication administration, and the control system 40 can evaluate themedication information from the medication guidelines database 60 inview of the patient-specific information for the patient associated withthe medical device 80 to determine if parameters entered into themedical device 60 fall within institutionally established guidelines forthe administration of a particular medication. If the comparisonindicates that the parameters or information entered into the medicationadministration device are appropriate in that they fall within theestablished guidelines, then an indication to that effect may beprovided to the caregiver and the caregiver may then begin medicationadministration.

Alternatively, if the comparison indicates that one or more parametersor information do not meet the established guidelines, a warning oralert may be provided to the caregiver that one or more parameters or aportion of information has been incorrectly entered into the medicationadministration device, and that corrective action or an override isrequired before medication administration can begin. In anotherembodiment, the medication administration device may be automaticallyinhibited from starting administration of a medication unless itreceives a signal from the control system 40 that the comparison wasfavorable, thus providing a fail-safe against incorrect administrationof the medication.

For example, a patient's laboratory testing results indicate the patienthas reduced renal function. The prescribed medication for the patient,however, will further reduce renal function in any patient, which, ifthe patient were to have normal renal function, would still fall withininstitutionally established guidelines as defined by the medicationguidelines database 60. This specific patient, however, has reducedrenal function. Based on the identification of specific information ofthe patient regarding the patient's reduced renal function, the controlsystem 40 will display an alert at the medical device 80 for providingthe prescribed medication, and optionally restrict a caregiver fromadministering the prescribed medication using the medical device 80.

In certain aspects, information may be retrieved information from themedical device 80 after actual medication administration begins, and thecontrol system 40 can evaluate the medication information from themedication guidelines database 60 in view of the patient-specificinformation for the patient associated with the medical device 80 todetermine if the parameters currently being used by the medical device60 fall within institutionally established guidelines for theadministration of a particular medication. For instance, the evaluationfor a medication being administered may occur during administration ofthe medication, such as when doses are adjusted, for example, tomaintain blood pressure or heart rate or blood sugar levels. Errors maythen be prevented and advisories posted at any point during themedication administration, which may be over 10 minutes, 10 hours, oreven 10 days.

Institutionally established guidelines or more widely accepted protocolsfor the administration of medications stored in the medicationguidelines database 60 include, for example, medication administrationparameters or other information, such as bolus size, maximum dose perhour, maximum continuous dose, volume to be infused, flow rate, andmaximum concentration. The medication guidelines database 60 may havepreestablished values for infusion parameters that have been generatedby the healthcare facility or adopted by the facility. They may comprisethe considered “best practices” of the facility and may be updated fromtime to time. These preestablished values may contain “hard” and “soft”limit values or dynamic guardrails on dosing parameters and otherinfusion parameters. The facility may set a soft limit for a druginfusion parameter that is a value not normally exceeded in theadministration of this drug, but which may be exceeded in exceptionalcircumstances. The facility may set a hard limit on a drug infusionparameter that is a value not to be exceeded in this facility.Similarly, the facility may set a soft limit value for a drug infusionparameter for doses that are below a normal range used by the facility,and a hard limit on a drug infusion parameter that is a value belowwhich a dose may not be given in the facility. In such circumstances, alow or high dose alert may be triggered to prevent potential underdosingor overdosing.

Once the infusion parameter values have been entered into the medicaldevice 80 by the caregiver and those values have been communicated tothe control system 40, the control system 40 may then enter averification stage in which it compares each of the selected valuesagainst the medication guidelines database 60 and patient-specificinformation from the patient information database 62 to verify that theentered infusion values are within acceptable ranges. If a valuecontravenes a hard limit, the control system 40 may generate an alarm atthe control system 40 or the medical device 80 and require a valuechange before operation of the medical device 80 can begin. If theselected infusion parameter value contravenes a soft limit, the controlsystem 40 may require an acknowledgment from the caregiver that he orshe understands that the value entered is outside a soft limit and thatthis value is nevertheless to remain in force before the medicationadministration can begin. In certain aspects, the control system 40 mayalso require that the caregiver provide a reason for entering the value.If the acknowledgment is obtained from the caregiver, the control system40 may authorize the administration of the medication by the medicaldevice 80.

The control system 40 is capable of retrieving medication administrationparameters or information from a medication administration device 80,and storing data or information concerning various transactions in itsmemory 42 representing the identity and treatment regimens formedications given to a patient, as well as other information, such ascaregiver identity, equipment location, patient vital signs information,or any other information sought to be recorded. The control system 40may also store data or information concerning primary or secondaryvalidation of previous and/or duplicate transactions of medicaltreatment information. The control system 40 may also provide, fordisplay, messages or other information to a caregiver, such as warningsor prompts to enter data, related to medication administration.Moreover, information entry means of the control system 40 may be usedfor manually entering information into the control system 40 for storagein the memory 42 of the control system 40. In certain aspects, thecontrol system 40 may store information in memory 42 representingpatient specific treatments spanning multiple treatments orhospitalizations. For example, the control system 40 may identify andtrack how much chemotherapy a patient receives in order to prevent amaximum dosage of chemotherapy over a time period being exceeded. Asanother example, the control system 40 may identify and track how muchalcohol is contained in a medication being provided to the patient inorder to prevent a certain amount of alcohol being exceeded for apatient having liver failure.

While specific examples of a control system 40 are set forth herein, itwill be understood that the control system 40 is meant to include anydevice that carries out the basic concept of the disclosure. That is, adevice that receives medication administration or treatment informationfrom a medication administration device, such as, for example, but notlimited to, an infusion pump or other instrument which performs similarfunctions, receives information specific to one or many patients, andhas a processor capable of comparing the received information toinstitutionally established medication administration guidelines orother pertinent information or data, such as drug interactioninformation and/or a library of possible side-effects, and thenproviding an indication of the result of the comparison to a caregiverbefore administration of a medication to a patient is begun, willaccomplish the aims of the present disclosure. A particularlyadvantageous embodiment includes storing information about themedication administration, such as the medication administration ortreatment parameters, and/or other information, such as the identity ofthe patient and caregiver, in the memory of the medications guidelinesdatabase 60 until the medications guidelines database 60 re-establishesa communication connection with the control system 40, whereby theinformation stored in the memory of the medications guidelines database60 may be communicated to the control system 40 and incorporated intoone or more of an institution's information databases. Similarly,information about the medication administration, such as the medicationadministration or treatment parameters, and/or other information, suchas the identity of the patient and caregiver, may be stored in thememory of the medical device 80 until, for example, the medical device80 re-establishes a communication connection with the control system 40.Updating the databases provides a verification that the treatment hasbeen rendered, thereby avoiding a duplicate treatment. In this manner,the present disclosure “closes the loop” ensuring that the rightmedication has been given in the right manner to the right patientthrough the rights route at the right time.

It is not unusual at present to find patient stations 70 having acomputer 72 located at patient bedsides in a healthcare facility. Suchstations 70 may serve a single patient, or may serve more than onepatient, depending on the design and arrangement of the patient area.There may also be a variety of equipment or clinical devices attached tothe bedside computer 72. Examples of such devices are a bar code reader74, a printer 76, patient monitoring equipment (not shown) formonitoring patient vital signs, or other patient-specific assets (e.g.,medical devices) assigned to the patient. Other infusion or drugdelivery devices and/or patient monitoring equipment such as cardiac orrespiratory monitors may also comprise or form a part of the medicaldevice.

The bedside equipment and clinical devices are typically equipped withdata communication technology such as RS 232 serial ports or proprietarycommunication ports that allow information and data to be communicatedto and from the equipment or clinical device. Using this communicationtechnology, the bedside equipment and clinical devices may be connectedto the bedside computer 72, or, alternatively, they may be connected,either by wire or wireless system, to the facility communication system30. Wireless technology, such as RF, infrared (IR), or other wirelesscommunication protocols, may be used, and wired technology establishinga local area network (LAN), Ethernet, or others may be used.

In accordance with an aspect of the present disclosure, the medicaldevice 80 may include a communication device 82 used to providecommunications between the medical device and the control system 40.Various forms of such a communication device may be used, such as wiredor wireless communication.

One particular mode of operation of the present disclosure will now bedescribed. A patient entering a healthcare facility is provided with awrist band, necklace, ankle band, or other band, chain, or devicedesigned to remain affixed to or embedded in the patient during thepatient's entire stay in the healthcare facility (the “patient ID”). Thepatient ID is designed to remain affixed in a manner so that the patientcan be identified even if unconscious or otherwise unresponsive. Thepatient ID is used to identify specific patient data, such as thepatient's name and other information that the facility has determined isimportant, such as age, allergies, or other vital information. Thepatient identifying device may comprise a bar code, written information,or an electronic information storage device, such as an RF transponder(e.g., RFID tag), that contains the information, or other device affixedto the patient. In the case where the patient-specification informationmay also include the patient's medication administration record (MAR).This would allow for consistent documentation and also checks againstdrug interaction in the medication guidelines database 60.

Such RFID tags, barcodes, and other technologies useful inidentification, may be applied to others and to other things inproviding healthcare to patients. For example, physicians, nurses, andother caregivers, as well as others who have access to patients andfacilities, may also have an RFID tag that can be read anywhere in thehealthcare facility. The medical fluid containers may contain RFID tagshaving information about the contents of the container as well as thepatient for whom they have been prepared, the pharmacist who preparedthem, and the physician who prescribed them. The infusion pumps andother healthcare instruments and devices may have RFID tags useful forinventory control. Even though the instruments may be connected to thehealthcare facility communication system 30, RFID tags can be useful formanual inventory purposes as well as for other purposes. Their low costmake them attractive as a backup support system.

After the patient is admitted and situated in a bed within the facility,the patient is typically evaluated by a physician and a course oftreatment is prescribed. The physician prescribes a course of treatmentby preparing an order that may request a series of laboratory tests orthe administration of a particular medication to the patient. In somecase, the physician prepares the order by filling in a form or writingthe order on a slip of paper to be entered into the healthcare facilitysystem for providing care. In other cases, the physician may enter themedication order directly into a physician order entry system 38(FIG. 1) or may instruct a nurse or other care-giving professional to doso. In yet another case, the physician may use the Internet to forwardand enter a prescription for the patient into the pharmacy system.Depending on the arrangement at the healthcare facility, the physician'sorder or prescription may directly reach a website for the pharmacyinformation system 36 or may go to a website for the healthcare facilitywhere it may then be routed to the pharmacy information system 36.

Pharmacy information systems 36 may enable a safer physician medicationorder process. The pharmacy information system 36 may provide thephysician with a list of available drugs from which the physician mayselect. The pharmacy information system 36 may contain a drug libraryhaving the list of available drugs but may also contain and present tothe physician the drug names associated with recommended dosages anddose limits that have been established or adopted by the healthcarefacility. In such a case where the physician need only select items fromthe computer screen rather than having to manually type in drug namesand drug administration numbers (such as infusion rates, times, etc.)associated with administration of the medication, a more accuratemedication process should result.

If the order is for administration of a particular medication regimen,the order will be transmitted to the facility's pharmacy informationsystem 36. The pharmacy reviews the order and prepares the medicationaccording to the requirements of the physician. Typically, the pharmacypackages the medication in a container, and a copy of the order, or at aminimum the patient's name, the drug name, and the appropriate treatmentparameters are represented on a label or other device that is affixed tothe drug container. This information may be represented by a bar code,or it may be stored in a smart label, such as a label having an embeddedcomputer, or in a passive device such as an RFID tag discussed above.

Once the order has been prepared, the order is sent to the nurse station44 for matching with the appropriate patient. Alternatively, if themedication is for a commonly or routinely prescribed medication, themedication may be included in an inventory of medications that is storedin a secure cabinet adjacent the nurse station 44. In such a case, thenurse station 44 will receive a list of orders from the pharmacyinformation system 36 that may be drawn from the inventory adjacent thenurse station 44. The caregiver will enter a unique identifier at thecabinet to gain access in accordance with standard practice. Thecaregiver or other professional assigned the task of gatheringmedications will then match the orders received from the pharmacyinformation system 60 to the medications stored in the inventory andpull those medications that are to be delivered to specific patients.These procedures are carried out whether the medication to be deliveredis an oral medication, or a medication that is to be deliveredintramuscularly or through an infusion.

When the prescribed time for delivery of the medication or medicationsarrives, the medications are carried to the patient's area andadministered to the patient by the caregiver. In the case of drugs to bedelivered via infusion, the caregiver hangs the infusion bag andprepares the infusion line, attaches the bag to an infusion pump 80, andsets up the infusion pump to deliver the medication by programming thepump with values for various parameters that are used by the pump tocontrol delivery of the medication to the patient. When the medicationdelivery parameters are entered into the pump, the pump communicates theentered parameters to the medications guidelines database 60 where theparameters are compared by the control system 40 to institutionallyestablished medication administration guidelines stored in themedication guidelines database 60 in view of patient-specificinformation from the patient information database 62. If the outcome ofthe comparison indicates that the entered parameters are within theguidelines, a message is provided to the caregiver informing thecaregiver that the entered parameters are acceptable and that deliveryof the medication may begin.

Alternatively, the infusion pump may include a fail-safe circuit ordevice that prohibits initiation of infusion until the medical device 80receives a signal from the medications guidelines database 60 that theentered parameters are within the institutionally established orapproved guidelines. Once such a signal is received by the infusionpump, the pump may be started to deliver the medication. Where thecomparison is not favorable, such as where one or more parameters falloutside of the institutionally established or approved guidelines, amessage to that effect is provided to the caregiver, and the caregiveris prompted to correct the out-of-range parameter or parameters, orenter an override. It will be understood by those skilled in the artthat these procedures may be embodied in a portable medicationsguidelines database 60 such as a PDA as described above, or they may beembodied in an MDC that is integrated in or associated with a particularmedical device.

FIG. 2 is a block diagram 200 illustrating an example control system 40(or “limiting system”), medical device 80, and server 130 from thearchitecture of FIG. 1 according to certain aspects of the disclosure.The control system 40, the medical device 80, and the server 130 areconnected over the network 30 via respective communications modules 210,156, and 138. The communications modules 210, 156, and 138 areconfigured to interface with the network 30 to send and receiveinformation, such as data, requests, responses, and commands to otherdevices on the network. The communications modules 210, 156, and 138 canbe, for example, modems or Ethernet cards and communicate over a wiredor wireless connection.

The control system 40 includes a processor 212, the communicationsmodule 210, and a memory 42 that includes a control application 208 anda medication guidelines database 60. The medication guidelines databaseincludes acceptable operating parameters for providing medication to apatient using the medical device 80. In certain aspects, the acceptableoperating parameters of the medication guidelines database 60 include aplurality of rules indicating whether the patient-specific informationincludes a value (e.g., physiological data reading) that is within orexceeds a threshold define by at least one of the rules. The rule canindicate, for example, a maximum or minimum total amount of themedication to provide to the patient over a period of time. For example,if a medication is provided solely based on an obese patient's weight,then the amount of the medication given over a one hour period maysignificantly exceed known safety limits. Accordingly, a limit may beplaced on delivery of the medication based on a total amount ofmedication delivered (as non-weight based) or the total amount deliveredover a period of time where the medication was programmed by the user asa weight based delivery. This addresses the patent of increased safetyduring medication delivery when programming an infusion as weight basedmedication and the limits for that medication are established within thehospital dataset as both 1) weight based limits and 2) non-weight based(not-to-exceed) limits. As such, the acceptable operating limitparameters in the medication guidelines database 60 can be hard or softlimits/guardrails. The acceptable operating limit parameters in themedication guidelines database 60 can include a rate at which to providethe medication, an amount of the medication to provide, and a length oftime to provide the medication.

The medical device 80 is configurable with operating limit parametersfor providing medication to a patient. The medical device 80 can be, forexample, an infusion pump or ventilator. The medical device 80 includesan input device 216, such as a keypad, for manual entry of operatingparameters 234 (e.g., dosing limits), as well as a display device 214,such as a monitor, for notifications and confirmation of enteredoperating parameters 234.

The processor 212 of the control system 40 is configured to executeinstructions, such as instructions physically coded into the processor212, instructions received from software in memory 42, or a combinationof both. For example, the processor 212 of the control system 40executes instructions to receive patient-specific information for apatient from a patient information database 62 stored in a memory 132 ofa server 130. The patient-specific information can be received from anexternal data system (e.g., server 130) in a native message format ofthe external data system, and the processor 212 of the control system 40can be configured to convert the patient-specific information into aninternal messaging format configured for use with the control system 40.The processor 212 can be configured to perform the conversion accordingto the system and method of converting messages being sent between datasystems using different communication protocols and message structuresdescribed in U.S. patent application Ser. No. 13/421,776, entitled“Scalable Communication System,” and filed on Mar. 15, 2012, thedisclosure of which is hereby incorporated by reference in its entiretyfor all purposes. The memory 42 of the control system 40 can include,for example, an interface module for communicating with the server 130.The interface module can include information on the communicationprotocol and data structure used by the server 130 and is configured toboth receive messages from and transmit messages to the server 130.

The processor 136 of the server 130 is configured to collect and storein the patient information database 62 patient-specific information fromthe physician order entry system 38, pharmacy information system 36, andhealthcare facility information system 34 over the network 30. Incertain aspects, the patient information database 62 can be stored inthe memory 42 of the control system 40. The patient-specific informationincludes, for example, laboratory data for a patient. The laboratorydata can include a blood coagulation measure, a vitamin level, aplatelet count value, a thromboplastin time, or a serum level for apatient. The patient-specific information can also include a medicationordered for the patient, a time at which the medication is ordered forthe patient, a treatment plan for the patient, a medication resistanceof the patient, a weight of the patient, a height of the patient, a bodysurface area of the patient, an age of the patient, a gender of thepatient, or an ethnicity of the patient.

The processor 212 of the control system 40 is configured to compare theacceptable operating parameters in the medication guidelines database 60with the patient-specific information from the patient informationdatabase 62, and provide a modification (e.g., by instructing aprocessor 143 of the medical device 80) the operating parameters 234 inthe memory 234 of the medical device 80 for providing the medication tothe patient based on the comparison of the acceptable operatingparameters with the patient-specific information. The modified operatingparameters 234 can be provided for display on the display device 214 ofthe medical device 80, or can automatically be implemented in theoperating parameters 234 of the medical device 80.

The processor 212 can, for example, modify the operating parameters 234based on the patient-specific information by defining at least one of amaximum value or minimum value for at least one operating parameter 234associated with delivery of the medication to the patient based on thepatient-specific information. The processor 212 can, for example, modifythe operating parameters 234 based on the patient-specific informationby defining at least one of a pair of a soft maximum value that can beexceeded and a hard maximum value that cannot be exceeded, or a softminimum value that can be exceeded and a hard minimum value that cannotbe exceeded for at least one operating parameter 234 associated withdelivery of the medication to the patient based on the patient-specificinformation from the patient information database 62.

Several examples of modifications made by the control system 40 to theoperating parameters 234 of the medical device 80 based onpatient-specific information and the medication guidelines database 60will now be presented. In one example, if information specific to apatient indicates the patient has two consecutive blood sugar resultsgreater than 180 mg/dL within a 24 hour period, then the operatingparameters 234 of the medical device 80 providing medication to thepatient can be modified by the control system 40 to reflect the patientsuffering from hyperglycemia. As a further example, if informationspecific to a patient indicates the patient has a blood sugar result ofless than 70 mg/dL, then the operating parameters 234 of the medicaldevice 80 providing medication to the patient can be modified by thecontrol system 40 to reflect the patient suffering from hypoglycemia(e.g., to decrease an amount of insulin being provided to the patient).As yet another example, if information specific to a patient indicatesthe patient has a serum potassium result of less than or equal to 3.2,then the operating parameters 234 of the medical device 80 providingmedication to the patient can be modified by the control system 40 toreflect the patient suffering from hypokalemia, and optionallyrecommending an increase an amount of potassium being provided to thepatient. As another example, if information specific to a patientindicates the patient has a serum potassium result of less than or equalto 3.5 while on digoxin or dofetilide, then the operating parameters 234of the medical device 80 providing medication to the patient can bemodified by the control system 40 to reflect the patient suffering fromhypokalemia while taking medications. As a further example, ifinformation specific to a patient indicates the patient has a serumpotassium result of greater than or equal to 5.0 while on angiotensinconverting enzyme inhibitors, angiotensin receptor II blockers,potassium sparing diuretics, potassium supplements, or aliskiren, thenthe operating parameters 234 of the medical device 80 providingmedication to the patient can be modified by the control system 40 toreflect the patient suffering from hyperkalemia while takingmedications. As another example, if information specific to a patientindicates the patient has a serum calcium result of less than 8.6 mg/dL,then the operating parameters 234 of the medical device 80 providingmedication to the patient can be modified by the control system 40 toreflect the patient suffering from hypocalcemia. As yet another example,if information specific to a patient indicates the patient has a serumcalcium result of greater than 10.2 mg/dL, then the operating parameters234 of the medical device 80 providing medication to the patient can bemodified by the control system 40 to reflect the patient suffering fromhypercalcemia. As a further example, if information specific to apatient indicates the patient has a serum magnesium result of less than1.5 mg/dL, then the operating parameters 234 of the medical device 80providing medication to the patient can be modified by the controlsystem 40 to reflect the patient suffering from hypomagnesemia.

As another example, if information specific to a patient indicates thepatient has a serum magnesium result of more than 2.4 mg/dL, then theoperating parameters 234 of the medical device 80 providing medicationto the patient can be modified by the control system 40 to reflect thepatient suffering from hypermagnesemia. As yet another example, ifinformation specific to a patient indicates the patient has a serumphosphate result of less than 2.7 mg/dL, then the operating parameters234 of the medical device 80 providing medication to the patient can bemodified by the control system 40 to reflect the patient suffering fromhypophosphatemia. As a further example, if information specific to apatient indicates the patient has a serum phosphate result of more 4.5mg/dL, then the operating parameters 234 of the medical device 80providing medication to the patient can be modified by the controlsystem 40 to reflect the patient suffering from hyperphosphatemia. Asanother example, if information specific to a patient indicates thepatient has a serum magnesium or serum phosphorus concentration above athreshold value (e.g., set by a user), then the operating parameters 234of the medical device 80 providing medication to the patient can bemodified by the control system 40 to reflect the patient suffering fromhigh or low magnesium or high or low phosphorus.

In one example, if information specific to a patient indicates thepatient has a blood coagulation measure or “INR” greater than 3.0, andVitamin K has been ordered for the patient within 24 hours of the INRcollected date and time, then the operating parameters 234 of themedical device 80 providing medication to the patient can be modified bythe control system 40 to reflect high INR and Vitamin K for the patient.As another example, if information specific to a patient indicates thepatient has an INR greater than 3.5 within 72 hours of an order ofWarfarin for the patient, then the operating parameters 234 of themedical device 80 providing medication to the patient can be modified bythe control system 40 to reflect high INR and Warfarin for the patient.As another example, if information specific to a patient indicates thepatient has platelet count less than 125,000/L, or that the patient'splatelet count has fallen by more than 50% while on (or within 14 hoursafter a discontinuation of) a certain medication, such as unfractionedheparin, dalteparin, enoxaparin, tinzaparin, or glycoprotein inhibitors,then the operating parameters 234 of the medical device 80 providingmedication to the patient can be modified by the control system 40 toreflect the patient suffering from thrombocytopenia and a critical dropin a drug. As another example, if information specific to a patientindicates the patient has not had a baseline platelet count within sevendays prior to the start of a scheduled dose of heparin, then theoperating parameters 234 of the medical device 80 providing medicationto the patient can be modified by the control system 40 to reflect nothaving a baseline platelet prior to starting heparin. As anotherexample, if information specific to a patient indicates the patient hasnot had a platelet count performed within a certain number of hours onceheparin has been active for four days, then the operating parameters 234of the medical device 80 providing medication to the patient can bemodified by the control system 40 to reflect no platelet count withinthe certain number of hours and having taken heparin for four days.

In certain aspects where the medical device 80 is configurable withoperating parameters 234 for providing a mixture comprising at least twomedications to a patient, the medication guidelines database 60 includesacceptable operating parameters for providing the mixture to the patientusing the medical device. For example, if an anesthetic agent (e.g.,Bupivacaine) is mixed with an analgesic agent (Fentanyl) in a singlesolution drug mixture cocktail, then the medication guidelines database60 can evaluate the concentration of the two agents and determine limitsfor dosing the drug mixture cocktail based on the concentration of thetwo agents in the drug mixture cocktail.

In certain aspects, the processor 212 of the control system 50 beingconfigured to compare the acceptable operating parameters from themedication guidelines database 60 with the patient-specific informationfrom the patient information database 62 includes the processorcomparing a first weight (e.g., lean body weight or total body weight)of the patient provided to the medical device 80 with a second weight(e.g., lean body weight or total body weight) of the patient provided toanother medical device. For example, on a first channel, a patient'sweight is based on lean body weight as 70 kilograms. On a secondchannel, the patient's weight is based on a total body weight of 80kilograms. In other words, the control system 50 permits two medicaldevices 80 to accept different weights of a patient for differentmedications. The system would further allow the institution to establishan allowable percent or absolute value of variance between weights usedon the same patient. For example if the allowed variance is 10%, thenall weights in the system would have to be within 10% of one another.This would prevent patient weight entry errors that can result inserious over or under dosing. This is covered in Paragraph 0063 as well.Such functionality is particularly relevant for very obese patients thatmay have a significant difference in their lean body weight and theirtotal body weight. Dosing a very obese patient that is based on totalbody weight can be inappropriate.

As such, the control system 40 is configured to place guardrails basedon a patient's weight. Specifically, the control system 40 is configuredto identify and compare the weight that is entered on the first channeland the second channel. For example, if an infusion is running on apediatric patient of 10 kilograms on a first channel and when a secondchannel is being prepared a default weight of 10 kilograms is enteredbased on the first channel. The clinician accidentally enters “110”kilograms as the weight of the pediatric patient on the second channel,which may cause the pediatric patient to receive about ten times theamount of the drug they would be prescribed simply because of theclinician's error. The control system 40 can indicate, for example, thatthe patient's weight being entered is out or differs by a certainpercentage (e.g., 10%, 20%) or by an absolute value, e.g., 5 pounds orkilograms set by a user or institution, and apply either hard or softlimits to the medication being provided to the patient.

In certain aspects, the processor 212 of the control system 50 beingconfigured to modify the operating parameters 234 of the medical device80 for providing the medication to the patient includes the processor212 being configured to modify the operating parameters 234 based on adetermination of the acceptable operating parameters for a person havingthe patient's body surface area (e.g., determined using information fromthe patient information database 62). Body surface area or actualsurface area of the patient can be a more accurate measure for dosemodification by the control system 40 for determining the operatingparameters 234 as compared to a patient's weight. In certain cases, abetter therapeutic response can be obtained for a medication if themedication is dosed based on a patient's body surface area as opposed tothe patient's weight. For example a lean patient weighing 350 lbs willhave less body surface area than an obese patient weighing 350 lbs. Ifbody surface area were not considered, then both patients would be giventhe same dose of a medication, which can be incorrect. If a medicationis provided to a patient based on the patient's weight, but the bodysurface area indicates that the patient is being provided too much ofthe medication as determined by the control system 40, then the controlsystem 40 can modify the operating parameters 234 accordingly.

Similarly, in certain aspects, the processor 212 of the control system50 being configured to modify the operating parameters 234 of themedical device 80 for providing the medication to the patient includesthe processor 212 being configured to modify the operating parameters234 based on a determination of the acceptable operating parameters fora person's weight. Patient weight can be an accurate measure for dosemodification by the control system 40 for determining the operatingparameters. In certain cases, a safer therapeutic response can beobtained for a medication if the medication does not exceed the maximumtotal dose (e.g., “not-to-exceed”) that is dosed based not a patient'sweight when the dose was programmed as a weight-based dose. For exampleif the medication was ordered by the physician and the dose was based onthe patients weight and the maximum total dose (not-to-exceed)non-weight based limit was exceed an alert will be displayed to the usertelling them the weight based dose programmed exceeds the hospitalestablished database maximum (not-to-exceed) non-weight based limit.350)

In certain aspects, the processor 212 of the control system 40 isconfigured to provide a notification to the medical device 80 indicatingthat the operating parameters 234 for providing the medication to thepatient have been modified based on the patient-specific informationfrom the patient information database 62. For example, the processor 212of the control system 40 can instruct the processor 154 of the medicaldevice 80 to display an alert with operating parameters 234 that havebeen modified by the control system 40 based on patient-specificinformation and the medication guidelines database 60. The display canbe seen by a clinician near the medical device 80. In certain aspects,the processor 212 is further configured to receive an input from acaregiver to override the modification of the operating parameters 234.Thus, the caregiver can override the modification provided by thecontrol system 40 by using the input device 216 of the medical device80. In addition to a confirmation to override the modified operatingparameters, the caregiver can also be required to provide a reason whythe caregiver has overrode the modification of the operating parameters234. The processor is configured to record when the caregiver overridesthe modification of the operating parameters 234, such as in the memory42 of the control system 40.

In certain aspects where the processor 212 of the control system 40 isconfigured to provide a notification to the medical device 80, theprocessor 212 is configured to receive configuration parameters fordetermining whether to provide the notification based on an identity ofa caregiver, identification of a location of the medical device, or aninstitutional preference. For example, the processor 212 can configurethe medical device 80 to require a confirmation step for operatingparameters 234 that exceed high limit warnings (e.g., a maximum amountfor a medication dose), but not for low limit warnings (e.g., a minimumamount for the medication dose). As another example, the processor 212can configure the medical device 80 to require a confirmation step forcertain critical medications, or for a first time a medication isprovided to a patient using the medical device 80. The configuration forwhen to display an alert and for what reasons can be set by aninstitution in which the medical device 80 is located.

As yet another example, the processor 212 can configure the medicaldevice 80 to display alerts and/or require a confirmation step based ona care area in which the medical device 80 is located or by thecaregiver associated with the medical device. For instance, in anoperating room, the operating parameters 234 for providing a medicationare usually very different than the operating parameters 234 forproviding a medication to a patient in a pediatric ward. The operatingparameters 234 of the medical device 80 can be configured or otherwisemodified by the control system 40 accordingly. As another example, if acaregiver associated with a medical device 80 is highly trained withover 10 years of experience, then an alert may not be displayed to thecaregiver as compared to another caregiver with limited experience.

FIG. 3 is functional block diagram illustrating an example process forreducing medication errors for a patient using a programmable medicaldevice 80 and a control system 40 by referencing a medication guidelinesdatabase 60 in view of information specific to the patient. Beginning instep 110, a caregiver programs a medical device 80 with operatingparameters 234 or other information necessary to deliver a particularmedication to a patient. Next, in step 112, a communication link betweenthe medical device 80 and the medications guidelines database 60 isestablished. In certain aspects, the communication link between themedical device 80 and the medications guidelines database 60 isestablished prior to the caregiver programming the medical device 80,where for example the medical device 80 may initially be programmed(e.g., for caregiver review and approval) by another system. The medicaldevice 80 communicates the operating parameters 234 or other informationto the control system 40 in step 114. The processor 212 of the controlsystem 40 then compares the communicated operating parameters 234 of themedical device 80 to institutionally established guidelines in themedication guidelines database 60 in view of patient-specificinformation for the patient received from the patient informationdatabase 62 of the server 130. In decision step 118, a determination ismade whether any of the operating parameters 234 of the medical device80 are out of range, that is, fall outside of the institutionallyestablished guidelines or limits of the medication guidelines database60 in view of the patient-specific information.

If it is determined that the operating parameters 234 of the medicaldevice 80 are within range in view of the patient-specific information,then the process proceeds to step 120 in which a confirmation messagefor the operating parameters 234 is sent to the medical device 80. Uponreceipt of this confirmation message, the medical device 80 unlocks andallows initiation of the medication delivery by the medical device 80.This approach would have particular application to the hard and softlimits feature in the drug library, as discussed above. Should a softlimit be contravened, an input to the medical device 80 from thecaregiver would be required before the control system 40 unlocks themedical device 80. Should a hard limit be contravened, the medicaldevice 80 would not be unlocked by the control system 40. Next, in step122, medication delivery by the medical device 80 is permitted toproceed.

If it is determined that any of the operating parameters 234 of themedical device 80 are out of range in view of the patient-specificinformation, then an alert is provided to the medical device 80 in step124. The alert can be audible, visible, or both. For example, messagessuch as “consistent” or “not inconsistent” may be provided thus givingthe caregiver further information upon which to base her decision as tousing the medical device 80. These latter messages may indicate that theparameters are “consistent” with the healthcare facility guidelinesstored in the control system 40. Next, in step 126, modified operatingparameters 234 determined by the control system 40 based on themedication guidelines database 60 in view of the patient specificinformation from the patient information database 62 are provided to themedical device 80. If the modified operating parameters 234 are acceptedin decision step 128, the process proceeds to step 120 described above.If the modified operating parameters 234 are not accepted in decisionstep 128, the process proceeds to beginning step 110 described above.

FIG. 4 is a block diagram illustrating an example computer system 400with which the control system 40, medical device 80, and server 130 ofFIG. 2 can be implemented. In certain aspects, the computer system 400may be implemented using hardware or a combination of software andhardware, either in a dedicated server, or integrated into anotherentity, or distributed across multiple entities.

Computer system 400 (e.g., control system 40, medical device 80, andserver 130) includes a bus 408 or other communication mechanism forcommunicating information, and a processor 402 (e.g., processor 212,154, and 136) coupled with bus 408 for processing information. By way ofexample, the computer system 400 may be implemented with one or moreprocessors 402. Processor 402 may be a general-purpose microprocessor, amicrocontroller, a Digital Signal Processor (DSP), an ApplicationSpecific Integrated Circuit (ASIC), a Field Programmable Gate Array(FPGA), a Programmable Logic Device (PLD), a controller, a statemachine, gated logic, discrete hardware components, or any othersuitable entity that can perform calculations or other manipulations ofinformation.

Computer system 400 can include, in addition to hardware, code thatcreates an execution environment for the computer program in question,e.g., code that constitutes processor firmware, a protocol stack, adatabase management system, an operating system, or a combination of oneor more of them stored in an included memory 404 (e.g., memory 42, 152,and 132), such as a Random Access Memory (RAM), a flash memory, a ReadOnly Memory (ROM), a Programmable Read-Only Memory (PROM), an ErasablePROM (EPROM), registers, a hard disk, a removable disk, a CD-ROM, a DVD,or any other suitable storage device, coupled to bus 408 for storinginformation and instructions to be executed by processor 402. Theprocessor 402 and the memory 404 can be supplemented by, or incorporatedin, special purpose logic circuitry.

The instructions may be stored in the memory 404 and implemented in oneor more computer program products, i.e., one or more modules of computerprogram instructions encoded on a computer readable medium for executionby, or to control the operation of, the computer system 400, andaccording to any method well known to those of skill in the art,including, but not limited to, computer languages such as data-orientedlanguages (e.g., SQL, dBase), system languages (e.g., C, Objective-C,C++, Assembly), architectural languages (e.g., Java, .NET), andapplication languages (e.g., PHP, Ruby, Perl, Python). Instructions mayalso be implemented in computer languages such as array languages,aspect-oriented languages, assembly languages, authoring languages,command line interface languages, compiled languages, concurrentlanguages, curly-bracket languages, dataflow languages, data-structuredlanguages, declarative languages, esoteric languages, extensionlanguages, fourth-generation languages, functional languages,interactive mode languages, interpreted languages, iterative languages,list-based languages, little languages, logic-based languages, machinelanguages, macro languages, metaprogramming languages, multiparadigmlanguages, numerical analysis, non-English-based languages,object-oriented class-based languages, object-oriented prototype-basedlanguages, off-side rule languages, procedural languages, reflectivelanguages, rule-based languages, scripting languages, stack-basedlanguages, synchronous languages, syntax handling languages, visuallanguages, wirth languages, embeddable languages, and xml-basedlanguages. Memory 404 may also be used for storing temporary variable orother intermediate information during execution of instructions to beexecuted by processor 402.

A computer program as discussed herein does not necessarily correspondto a file in a file system. A program can be stored in a portion of afile that holds other programs or data (e.g., one or more scripts storedin a markup language document), in a single file dedicated to theprogram in question, or in multiple coordinated files (e.g., files thatstore one or more modules, subprograms, or portions of code). A computerprogram can be deployed to be executed on one computer or on multiplecomputers that are located at one site or distributed across multiplesites and interconnected by a communication network. The processes andlogic flows described in this specification can be performed by one ormore programmable processors executing one or more computer programs toperform functions by operating on input data and generating output.

Computer system 400 further includes a data storage device 406 such as amagnetic disk or optical disk, coupled to bus 408 for storinginformation and instructions. Computer system 400 may be coupled viainput/output module 410 to various devices. The input/output module 410can be any input/output module. Example input/output modules 410 includedata ports such as USB ports. The input/output module 410 is configuredto connect to a communications module 412. Example communicationsmodules 412 (e.g., communications module 210, 156, and 138) includenetworking interface cards, such as Ethernet cards and modems. Incertain aspects, the input/output module 410 is configured to connect toa plurality of devices, such as an input device 414 (e.g., input device216) and/or an output device 416 (e.g., display device 214). Exampleinput devices 414 include a keyboard and a pointing device, e.g., amouse or a trackball, by which a user can provide input to the computersystem 400. Other kinds of input devices 414 can be used to provide forinteraction with a user as well, such as a tactile input device, visualinput device, audio input device, or brain-computer interface device.For example, feedback provided to the user can be any form of sensoryfeedback, e.g., visual feedback, auditory feedback, or tactile feedback;and input from the user can be received in any form, including acoustic,speech, tactile, or brain wave input. Example output devices 416 includedisplay devices, such as a LED (light emitting diode), CRT (cathode raytube), or LCD (liquid crystal display) screen, for displayinginformation to the user.

According to one aspect of the present disclosure, the control system40, medical device 80, and server 130 can be implemented using acomputer system 400 in response to processor 402 executing one or moresequences of one or more instructions contained in memory 404. Suchinstructions may be read into memory 404 from another machine-readablemedium, such as data storage device 406. Execution of the sequences ofinstructions contained in main memory 404 causes processor 402 toperform the process steps described herein. One or more processors in amulti-processing arrangement may also be employed to execute thesequences of instructions contained in memory 404. In alternativeaspects, hard-wired circuitry may be used in place of or in combinationwith software instructions to implement various aspects of the presentdisclosure. Thus, aspects of the present disclosure are not limited toany specific combination of hardware circuitry and software.

Various aspects of the subject matter described in this specificationcan be implemented in a computing system that includes a back endcomponent, e.g., as a data server, or that includes a middlewarecomponent, e.g., an application server, or that includes a front endcomponent, e.g., a client computer having a graphical user interface ora Web browser through which a user can interact with an implementationof the subject matter described in this specification, or anycombination of one or more such back end, middleware, or front endcomponents. The components of the system can be interconnected by anyform or medium of digital data communication, e.g., a communicationnetwork. The communication network (e.g., network 30) can include, forexample, any one or more of a personal area network (PAN), a local areanetwork (LAN), a campus area network (CAN), a metropolitan area network(MAN), a wide area network (WAN), a broadband network (BBN), theInternet, and the like. Further, the communication network can include,but is not limited to, for example, any one or more of the followingnetwork topologies, including a bus network, a star network, a ringnetwork, a mesh network, a star-bus network, tree or hierarchicalnetwork, or the like. The communications modules can be, for example,modems or Ethernet cards.

Computing system 400 can include clients and servers. A client andserver are generally remote from each other and typically interactthrough a communication network. The relationship of client and serverarises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other.Computer system 400 can be, for example, and without limitation, adesktop computer, laptop computer, or tablet computer. Computer system400 can also be embedded in another device, for example, and withoutlimitation, a mobile telephone, a personal digital assistant (PDA), amobile audio player, a Global Positioning System (GPS) receiver, a videogame console, and/or a television set top box.

The term “machine-readable storage medium” or “computer readable medium”as used herein refers to any medium or media that participates inproviding instructions or data to processor 402 for execution. Such amedium may take many forms, including, but not limited to, non-volatilemedia, volatile media, and transmission media. Non-volatile mediainclude, for example, optical disks, magnetic disks, or flash memory,such as data storage device 406. Volatile media include dynamic memory,such as memory 404. Transmission media include coaxial cables, copperwire, and fiber optics, including the wires that comprise bus 408.Common forms of machine-readable media include, for example, floppydisk, a flexible disk, hard disk, magnetic tape, any other magneticmedium, a CD-ROM, DVD, any other optical medium, punch cards, papertape, any other physical medium with patterns of holes, a RAM, a PROM,an EPROM, a FLASH EPROM, any other memory chip or cartridge, or anyother medium from which a computer can read. The machine-readablestorage medium can be a machine-readable storage device, amachine-readable storage substrate, a memory device, a composition ofmatter effecting a machine-readable propagated signal, or a combinationof one or more of them.

As used herein, the phrase “at least one of” preceding a series ofitems, with the terms “and” or “or” to separate any of the items,modifies the list as a whole, rather than each member of the list (i.e.,each item). The phrase “at least one of” does not require selection ofat least one item; rather, the phrase allows a meaning that includes atleast one of any one of the items, and/or at least one of anycombination of the items, and/or at least one of each of the items. Byway of example, the phrases “at least one of A, B, and C” or “at leastone of A, B, or C” each refer to only A, only B, or only C; anycombination of A, B, and C; and/or at least one of each of A, B, and C.

Furthermore, to the extent that the term “include,” “have,” or the likeis used in the description or the claims, such term is intended to beinclusive in a manner similar to the term “comprise” as “comprise” isinterpreted when employed as a transitional word in a claim.

A reference to an element in the singular is not intended to mean “oneand only one” unless specifically stated, but rather “one or more.” Theterm “some” refers to one or more. All structural and functionalequivalents to the elements of the various configurations describedthroughout this disclosure that are known or later come to be known tothose of ordinary skill in the art are expressly incorporated herein byreference and intended to be encompassed by the subject technology.Moreover, nothing disclosed herein is intended to be dedicated to thepublic regardless of whether such disclosure is explicitly recited inthe above description.

While this specification contains many specifics, these should not beconstrued as limitations on the scope of what may be claimed, but ratheras descriptions of particular implementations of the subject matter.Certain features that are described in this specification in the contextof separate embodiments can also be implemented in combination in asingle embodiment. Conversely, various features that are described inthe context of a single embodiment can also be implemented in multipleembodiments separately or in any suitable subcombination. Moreover,although features may be described above as acting in certaincombinations and even initially claimed as such, one or more featuresfrom a claimed combination can in some cases be excised from thecombination, and the claimed combination may be directed to asubcombination or variation of a subcombination.

Similarly, while operations are depicted in the drawings in a particularorder, this should not be understood as requiring that such operationsbe performed in the particular order shown or in sequential order, orthat all illustrated operations be performed, to achieve desirableresults. In certain circumstances, multitasking and parallel processingmay be advantageous. Moreover, the separation of various systemcomponents in the aspects described above should not be understood asrequiring such separation in all aspects, and it should be understoodthat the described program components and systems can generally beintegrated together in a single software product or packaged intomultiple software products.

The subject matter of this specification has been described in terms ofparticular aspects, but other aspects can be implemented and are withinthe scope of the following claims. For example, the actions recited inthe claims can be performed in a different order and still achievedesirable results. As one example, the processes depicted in theaccompanying figures do not necessarily require the particular ordershown, or sequential order, to achieve desirable results. In certainimplementations, multitasking and parallel processing may beadvantageous. Other variations are within the scope of the followingclaims.

These and other implementations are within the scope of the followingclaims.

What is claimed is:
 1. A system for use with a medical device forreducing medication errors, the system comprising: a medical device thatis configurable with operating limit parameters for providing medicationto a patient; and a limiting system comprising: a memory comprisingpatient-specific information for the patient and a database comprisingacceptable operating parameters for providing the medication to thepatient using the medical device, the patient-specific informationcomprising laboratory data for the patient, the laboratory datacomprising at least one of a blood coagulation measure, a vitamin level,a platelet count value, a thromboplastin time, or a serum level; aprocessor configured to: compare the acceptable operating parameterswith the laboratory data for the patient before and duringadministration of the medication to the patient; provide a modificationof the operating limit parameters for providing the medication to thepatient based on the comparison of the laboratory data for the patientwith the acceptable operating parameters; and provide a notification fordisplay by the medical device indicating that the operating limitparameters for providing the medication to the patient have beenmodified based on the patient-specific information, the notificationcomprising information regarding the modified operating limitparameters.
 2. The system of claim 1, wherein the patient-specificinformation is received over a network from a healthcare facilityinformation system in a native message format of the healthcare facilityinformation system and converted into an internal messaging formatconfigured for use with the limiting system.
 3. The system of claim 1,wherein the medical device is configurable with operating limitparameters for providing a mixture comprising a plurality of medicationsto a patient, and wherein the database comprises acceptable operatingparameters for providing the mixture to the patient using the medicaldevice.
 4. The system of claim 1, wherein the patient-specificinformation comprises at least one of a medication ordered for thepatient, a time at which the medication is ordered for the patient, atreatment plan for the patient, a medication resistance of the patient,a weight of the patient, a height of the patient, a body surface area ofthe patient, an age of the patient, a gender of the patient, a geneticmakeup of the patient, or an ethnicity of the patient, and wherein theprocessor being configured to compare the acceptable operatingparameters with the patient-specific information comprises the processorcomparing a first weight of the patient provided to the medical devicewith a second weight of the patient provided to another medical device.5. The system of claim 4, wherein the processor being configured toprovide the modification of the operating limit parameters for providingthe medication to the patient comprises the processor being configuredto modify the operating limit parameters based on a determination of theacceptable operating parameters for a person having the patient's bodysurface area.
 6. The system of claim 1, wherein the acceptable operatingparameters comprise a plurality of rules indicating whether thepatient-specific information comprises a value that is within or exceedsa threshold define by at least one of the plurality of rules, andwherein at least one of the rules indicates a maximum total amount ofthe medication to provide to the patient, or a maximum total amount ofthe medication to provide to the patient over a period of time.
 7. Thesystem of claim 1, wherein the medical device comprises an infusionpump.
 8. The system of claim 1, wherein the operating limit parameterscomprise at least one of a rate at which to provide the medication, anamount of the medication to provide, and a length of time to provide themedication.
 9. The system of claim 1, wherein the processor beingconfigured to provide the modification of the operating limit parametersbased on the patient-specific information comprises the processor beingconfigured to define at least one of a pair of a soft maximum value thatcan be exceeded and a hard maximum value that cannot be exceeded, or asoft minimum value that can be exceeded and a hard minimum value thatcannot be exceeded for at least one operating limit parameter associatedwith delivery of the medication to the patient based on thepatient-specific information.
 10. The system of claim 1, wherein theprocessor is further configured to receive an input from a caregiver tooverride the modification of the operating limit parameters.
 11. Thesystem of claim 10, wherein the input from the caregiver comprises anindication why the caregiver overrode the modification of the operatinglimit parameters, and wherein the processor is further configured torecord when the caregiver overrides the modification of the operatinglimit parameters.
 12. The system of claim 1, wherein the processor isfurther configured to receive configuration parameters for determiningwhether to provide the notification to the medical device based on atleast one of an identity of a caregiver, identification of a location ofthe medical device, or an institutional preference.
 13. The system ofclaim 1, wherein the comparison of the acceptable operating parameterswith the patient-specific information is configured to occur before andduring administration of the medication to the patient.
 14. A method foruse with a medical device to reduce medication errors, the methodcomprising: receiving patient-specific information for a patient, thepatient-specific information comprising laboratory data for the patient,the laboratory data comprising at least one of a blood coagulationmeasure, a vitamin level, a platelet count value, a thromboplastin time,or a serum level; comparing the laboratory data for the patient with adatabase comprising acceptable operating parameters for a medical devicebefore and during administration of the medication to the patient;providing a modification of operating limit parameters of the medicaldevice for providing a medication to the patient based on the comparisonof the laboratory data for the patient with the acceptable operatingparameters; and providing a notification for display by the medicaldevice indicating that the operating limit parameters for providing themedication to the patient have been modified based on thepatient-specific information, the notification comprising informationregarding the modified operating limit parameters.
 15. The method ofclaim 14, wherein the operating limit parameters of the medical deviceare modified by a limiting system, and wherein the patient-specificinformation is received over a network from a healthcare facilityinformation system in a native message format of the healthcare facilityinformation system and converted into an internal messaging formatconfigured for use with the limiting system.
 16. The method of claim 14,wherein the medical device is configurable with operating limitparameters for providing a mixture comprising a plurality of medicationsto a patient, wherein the database comprises acceptable operatingparameters for providing the mixture to the patient using the medicaldevice.
 17. The method of claim 14, wherein the patient-specificinformation comprises at least one of a medication ordered for thepatient, a time at which the medication is ordered for the patient, atreatment plan for the patient, a medication resistance of the patient,a weight of the patient, a height of the patient, a body surface area ofthe patient, an age of the patient, a gender of the patient, a geneticmakeup of the patient, or an ethnicity of the patient, and whereincomparing the acceptable operating parameters with the patient-specificinformation comprises comparing a first weight of the patient providedto the medical device with a second weight of the patient provided toanother medical device.
 18. The method of claim 17, wherein providingthe modification of the operating limit parameters for providing themedication to the patient comprises modifying the operating limitparameters based on a determination of the acceptable operatingparameters for a person having the patient's body surface area.
 19. Themethod of claim 14, wherein the acceptable operating parameters comprisea plurality of rules indicating whether the patient-specific informationcomprises a value that is within or exceeds a threshold define by atleast one of the plurality of rules, and wherein at least one of therules indicates a maximum total amount of the medication to provide tothe patient, or a maximum total amount of the medication to provide tothe patient over a period of time.
 20. The method of claim 14, whereinthe medical device comprises an infusion pump.
 21. The method of claim14, wherein the operating limit parameters comprise at least one of arate at which to provide the medication, an amount of the medication toprovide, and a length of time to provide the medication.
 22. The methodof claim 14, wherein providing the modification of the operating limitparameters based on the patient-specific information comprises definingat least one of a pair of a soft maximum value that can be exceeded anda hard maximum value that cannot be exceeded, or a soft minimum valuethat can be exceeded and a hard minimum value that cannot be exceededfor at least one operating limit parameter associated with delivery ofthe medication to the patient based on the patient-specific information.23. The method of claim 14, the method further comprising receiving aninput from a caregiver to override the modification of the operatinglimit parameters.
 24. The method of claim 23, wherein the input from thecaregiver comprises an indication why the caregiver overrode themodification of the operating limit parameters, and the method furthercomprising recording when the caregiver overrides the modification ofthe operating limit parameters.
 25. The method of claim 14, the methodfurther comprising receiving configuration parameters for determiningwhether to provide the notification to the medical device based on atleast one of an identity of a caregiver, identification of a location ofthe medical device, or an institutional preference.
 26. A non-transitorymachine-readable storage medium comprising machine-readable instructionsfor causing a processor to execute a method for use with a medicaldevice to reduce medication errors, the method comprising: receivingpatient-specific information for a patient, the patient-specificinformation comprising laboratory data for the patient, the laboratorydata comprising at least one of a blood coagulation measure, a vitaminlevel, a platelet count value, a thromboplastin time, or a serum level;comparing the laboratory data for the patient with a database comprisingacceptable operating parameters for a medical device before and duringadministration of the medication to the patient; providing themodification of operating limit parameters of the medical device forproviding a medication to the patient based on the comparison of thelaboratory data for the patient with the acceptable operatingparameters; and providing a notification for display by the medicaldevice indicating that the operating limit parameters for providing themedication to the patient have been modified based on thepatient-specific information, the notification comprising informationregarding the modified operating limit parameters.
 27. The system ofclaim 1, wherein the modification of the operating limit parameters isautomatic, or presented to a clinician for validation.